Table of Contents

Focus of Research for Clinicians

To review the role of self-measured blood pressure (SMBP) monitoring with or without additional support (interventions such as telemonitoring, counseling, education, Web support, behavioral interventions, home visits, etc.) in the management of hypertension, a systematic review of 49 studies examined the comparative effectiveness and adherence predictors of SMBP monitoring. The review addressed SMBP monitoring performed by the patient or the patient’s companion at home; it did not include monitoring done at the doctor’s office, clinic, pharmacy, or health unit at work, nor did it include blood pressure (BP) monitoring done at home by nurses or other health care professionals. The full report, listing all studies, is available at www.effectivehealthcare.ahrq.gov/selfmeasuredbp.cfm. This summary is provided to assist in clinical decisionmaking along with consideration of a patient’s values and preferences. However, reviews of evidence should not be construed to represent clinical recommendations or guidelines.

Background

High BP or hypertension (BP ≥140/90 mmHg) is a common, ongoing health condition, affecting 1 in 3 adults in the United States aged 20 or older. Hypertension has been identified as a major risk factor for cardiovascular disease and an important modifiable risk factor for acute myocardial infarction, stroke, congestive heart failure, and chronic kidney disease. Key strategies for managing hypertension include lifestyle and behavior modifications (such as dietary modification, weight loss, and regular exercise), usually combined with medication. Estimates indicate that a decrease of 5 mmHg in systolic BP can significantly reduce morbidity and mortality. However, long-term adherence to lifestyle modifications and medication remains a significant challenge in managing this condition.

While SMBP monitoring may improve patient participation in chronic disease management, the effects of this strategy on BP, clinical outcomes, and health care utilization remain uncertain.

Conclusions

In the management of hypertension, SMBP alone versus usual care yielded a modest reduction in clinic systolic BP (SBP) and diastolic BP (DBP) at 6 months (SBP/DBP -3.1/-2.0 mmHg) and 12 months (SBP/DBP -1.2/-0.8 mmHg). Meta-analyses showed that the net reduction in SBP and DBP was statistically significant at 6 months but not at 12 months. Combining additional support with SMBP monitoring led to greater BP reduction when compared to usual care at up to 12 months of followup based on consistent findings in six high-quality studies. However, the evidence was too limited to determine the superiority of any one form of clinical support, as modalities varied widely across studies. The evidence is weak or insufficient to determine if SMBP with or without additional support has an impact on other outcomes (including mortality, quality of life, number of medications used, medication adherence, and health care encounters). Additional research is needed to determine the effect of SMBP on BP control beyond 12 months and to determine long-term clinical consequences of SMBP.

This summary was prepared by the John M. Eisenberg Center for Clinical Decisions and Communications Science at Baylor College of Medicine, Houston, TX. It was written by Geetha Achanta, Ph.D., Amelia Williamson Smith, M.S., Thomas Workman, Ph.D., Sarah Michel, M.P.H., James Pool, M.D., and Michael Fordis, M.D.